Galloway: Health Care Odyssey

(HOST) Commentator Anne Galloway has a personal story about how challenging it is for one individual to do her part in helping to reform the health care system.

(GALLOWAY) There's been a lot of talk about the inefficiencies of the health care system.

In what is a self-perpetuating negative feedback loop, insurers make money by denying or delaying coverage, the government cuts payments to health care providers as costs go up, and hospitals and doctors shift those expenses to insured patients.

Still, the complexity of the system can seem abstract, unless you happen to be embroiled, as I am, in an insurance company-health care paper chase.

In January, I had a biopsy. It's nearly June, and though I have a clean bill of health, I have not yet fully resolved the bill for that single procedure, even though my inner comptroller has been working overtime from the get-go.

Before my outpatient appointment, I spoke with the health insurer, the surgeon's office and the hospital to verify I would be covered for the procedure.

Since then, I've made 31 phone calls and spent more than 10 hours on the telephone -much of that on hold - with billing offices, the health insurer and the health reimbursement arrangement company. I've mailed and faxed explanation of benefit statements and claim forms for the biopsy three times.

Here's what I've discovered over the last four months: The initial hospital bill was more than $10,000, not including more than $2,000 for the surgeon and nearly $500 for the radiologist.

The surgeon's bill was coded incorrectly, so it had to be resubmitted to the insurance company, which led to a two month delay. The original hospital bill was audited by the health insurer; then it was held up for six weeks because of a $5 discrepancy. Eventually, the insurer "allowed" the hospital to charge about $3,200, and the surgeon to bill about $1,000.

This kind of bureaucratic red tape is perhaps inevitable in a system in which the cost drivers are complex and consumers receive "blank check" services.

Many patients don't need to know how much a procedure costs, because a private company or the government foots the bill. My family, however, is covered under a high-deductible health care plan, and it's incumbent on me to keep track of our expenses.
(If the HRA payment comes through, our out-of-pocket expenses will be about $2,500.)

You probably wouldn't embark on a home improvement project without getting an estimate from a contractor, but when was the last time you went into a hospital with a rough idea of what, say, a CT scan costs?

Part of the problem is that Medicare, Medicaid, uninsured and insured patients all pay different rates for services, leaving one to wonder what the actual cost of a procedure is, and whether it wouldn't be best to use real numbers to start with.

How could the hospital charge me $10,000, then reduce the bill to $3,200? I wish I could answer that question. Transparency clearly is an issue in our current system. Ironically, public disclosure of health care fees, which could induce fundamental reforms, wouldn't cost a dime. The only required expenditure would be political will.